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Nigeria

Nigeria’s rapidly increasing population has created pressure on its health system. High birth rates are accompanied by one of the lowest case detection rates among high tuberculosis burden countries. Uptake of family planning services is low while unmet need is very high. It has the second largest HIV epidemic in the world. The private sector is the preferred source of contraceptives, and an underused resource for diagnosis of tuberculosis and providing HIV services.

41%

of caregivers access diarrhea treatment in the private sector

19%

of under-5 mortality is due to diarrhea

27%

of women in urban areas and 9% in rural areas use contraceptives

65%

of the population seek health services from the private sector

Nigeria is the seventh most populous country in the world with 193 million people. The most recent national health accounts data estimate that 68% of health expenditures occur in the private sector; therefore, it is imperative that facilities in both the private and public sectors provide quality services. The SHOPS Plus program focuses on family planning, tuberculosis, and HIV.

Family planning
The limited availability of trained providers, of a range of contraceptive methods including long-acting reversible contraceptives at the community health worker level, continues to be a significant barrier to family planning services resulting in the low use of modern contraceptives. Therefore, increasing access to quality training for these providers is essential.

SHOPS Plus is working to enhance the existing provider training and supervision systems to improve and maintain provider clinical skills and attitudes, which will result in increased uptake of family planning. The project will collaborate with other USAID projects (Breakthrough Action and Procurement Supply Management) to address social and behavior change as well as contraceptive commodity security.

Tuberculosis
Despite its high incidence of tuberculosis, Nigeria has one of the lowest case detection rates among high tuberculosis burden countries. With an estimated 407,000 cases in 2016 according to WHO, less than a quarter of this number was reported as receiving treatment. Strengthening the private sector’s capacity to detect and treat tuberculosis is vital to reducing the incidence rate of tuberculosis in the country.

SHOPS Plus’ approach to increasing the availability of and access to TB services in the private sector in Lagos and Kano states, the two states with the highest TB burden and high levels of private sector activity, aligns with both international standards and the country’s national plan for tuberculosis control. SHOPS Plus is establishing and supporting networks made up of different cadres of private providers to detect, diagnose, follow up, and treat tuberculosis. These cadres are not limited to clinical providers but also include proprietary patent medicine vendors, community pharmacists and private laboratories because these cadres are often the first point of contact for most care-seeking Nigerians.

Program Components

SHOPS Plus is training and enrolling vendors and pharmacists in each health facility’s catchment area into networks so that they can refer people with presumed tuberculosis to the participating health facilities.

SHOPS Plus will address provider-related barriers to family planning by addressing training, mentorship, and supervision, which have been inadequate for building competence and confidence among public and private providers.

SHOPS Plus will build the capacity of private sector facilities to deliver high quality tuberculosis care through training and continuous quality improvement processes in collaboration with National TB and Leprosy Control Program.

To scale up use of HIV services through the private sector in Rivers and Lagos states, SHOPS Plus completed an assessment of the health system in each state, as well as the market for HIV services, and identified private service delivery models that could bridge any gaps between supply and demand.

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Sustaining Health Outcomes through the Private Sector (SHOPS) Plus is a five-year cooperative agreement (AID-OAA-A-15-00067) funded by the United States Agency for International Development (USAID). This website is made possible by the generous support of the American people through USAID. The information provided on this website is not official U.S. government information and does not represent the views or positions of USAID or the U.S. government.